Individual
DR. BELLA T PROSPERO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
17901 GOVERNORS HWY, SUITE 101, HOMEWOOD, IL 60430-1144
(708) 799-7193
(708) 799-3839
Mailing address
PO BOX 1119, MATTESON, IL 60443-4119
(708) 747-5850
(708) 747-9991
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036058672
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01635492
BCBSIL GROUP NUMBER
—
05
—
036058672
—
IL
Enumeration date
07/28/2005
Last updated
01/15/2013
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